May 19, 2010

CANADA: End of life care 'inadequate,' reports Cancer Society

OTTAWA, Ontario / The Ottawa Citizen / Health / May 19, 2010

By Sharon Kirkey, Canwest News Service

Volunteers assemble bunches of daffodils for the
Canadian Cancer Society's annual fundraiser in Ottawa. 
File Photograph by: Pat McGrath, Ottawa Citizen

Given the choice, most people with terminal cancer would prefer to die at home. But nearly 60 per cent per cent of all cancer deaths in Canada occur in hospital because of a patchwork of end of life care across the nation, a new report warns.

For those who die in hospital, a "substantial" proportion of deaths are occurring not in specialized, palliative care beds, but on busy and already overloaded surgical or medical wards, or intensive care units.

The goal, says the special report released Wednesday as part of the Canadian Cancer Society's annual update on cancer statistics, "should be uniform, high-quality support for any person dying of cancer no matter where they live."

Instead, services to allow people to die at home are inadequate, underused or used too late because of delays in referring patients, the report, based on data from British Columbia, Ontario and Nova Scotia found.

And the financial burden on families is considerable: caregivers spend, on average, $36 a day, or more than $1,000 a month, to take care of a loved one dying at home.

That doesn't include income lost due to time off work.

Cancer is the leading cause of death in Canada. In 2005, the most recent year for which data is available, 29 per cent of all deaths in Canada — approximately 67,300 deaths — were from cancer.

A growing and aging population means the numbers will only increase.

"People who are dying from cancer — and their caregivers — need more support," says Heather Chappell, director of cancer control policy at the Canadian Cancer Society.

"People should be able to access high-quality palliative care services, regardless of where they live in Canada. That's not the case from the data we're seeing."

The society says compassionate care benefits for caregivers should be increased to 26 weeks from six weeks.

"Six weeks is too short and doesn't consider the unpredictability of death," Aaron Levo, acting director of public issues, said in a media statement.

It is also recommending a caregiver tax benefit, paid monthly, to help with costs related to caring for a patient at home. "It is simply not acceptable for a person already giving so much to support others, to carry an additional financial burden related to caregiving responsibilities," Levo said.

While the number of cancer deaths is increasing in both sexes as the population grows and ages, overall rates of cancer death — the number of deaths per 100,000 people — are either falling or holding steady, according to Canadian Cancer Statistics 2010. For breast cancer — the most frequently diagnosed cancer among Canadian women — the death rate has dropped by more than 30 per cent since 1986, likely due to earlier detection and improved treatment.

In 2010, there will be an estimated 173,800 new cases of cancer — an increase of 2,800 over last year.

There will be an estimated 76,200 deaths from cancer, up 900 from the previous year.

This year, lung cancer is expected to hold its rank as the No. 1 cause of cancer death for both men and women.

For reasons that aren't clear, thyroid cancer is increasing in both sexes, especially among women. [rc]

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